Female reproductive

disorders
 CANDIDIASIS
• Fungal/Yeast Infection; occur at any time; occur more commonly in pregnancy or with
systemic condition (i.e. DM, HIV) or pt takes med (i.e. corticosteroid or contraceptive
agents)
• Signs and Symptoms:
- itching, vaginal discharge (watery/thick but has white, cottage cheese-like
appearance) that causes pruritus and irritation
- sx more severe before menstruation and less responsive to tx during pregnancy
• Diagnosis:
- made by microscopic identification of spores and hyphae
- Sample Discharge Sent To Laboratory
- pH is 4.5 or less
• Treatment (goal is to eliminate sx):
- Antifungal Medications:
➡ fluconazole (Diflucan) is one-pill dose. Relief should noted within 3 days
➡ miconazole (Monistat), nystatin (Mycostatin), clotrimazole (Gyne-Lotrimin) and
terconazole (Terazol) cream. These agents inserted into vagina with an applicator at
bedtime
- Monistat, Mycostatin instead into vagina with applicators at bedtime
-
 Bacterial vaginosis
• Caused by overgrowth of anaerobic bacteria and Gardnerella vaginalis
• Risk factor: douching after menses, smoking, multiple sex partners, other
STIs
• Not considered as STI but associated with sexual activity and increased in
female same-sex partners
• Signs & Symptoms:
- they do not have pain or discomfort, most of pt do not notice any sx.
- Discharged, if noticed, is heavier than normal and gray to yellowish
white in color. Fishlike odor
- pH is greater than 4.7
• Associated with premature labor, premature rupture of membranes,
endometritis, and pelvic infection
• Management:
- Metronidazole (Flagyl) given orally bid for 1 wk, Clindamycin (Cleocin)
vaginal cream or ovules (oval suppositories)
- Disease is highly persistent and tends to recur after tx, need to seek
follow-up care if sx recur
 Trichomoniasis
• STD: Caused By Protozoan Parasite, common STI “trich”
• Transmitted by asymptomatic carrier who harbors the
organism in urogenital tract
• Increases Risk For HIV Transmission (any STI increase the
risk).
• More common in African-American women
• S/S: Vaginal Discharge (frothy yellowish to yellow-green),
vulvovaginal burning and itching .
• Can become chronic, can go to anus and bladder
• Not Commonly Seen In Males: mild penis
 Trichomoniasis
• Spread By Carriers
• Diagnosis: culture of discharge. Microscopic detection of motile
causative organism or less frequently by culture. Inspection with
speculum often reveals vaginal & cervical erythema (redness) w/
multiple small petechiae (“strawberry spots”)
• Treatment: Most Effective Is Medications (tinidazole (Tindamax)-
drug of choice since it is cheaper and metronidazole)
- May complain of unpleasant but transient metallic taste when
taking metronidazole
- N/V, hot & flushed feeling occur when med is taken with
alcoholic beverage
- Advise to abstain from alcohol during tx and for 24 hrs after
taking metronidazole or 72 hrs after completion of a course of
tinidazole
• Treat Both Partners
 Nursing process: The patient with a vulvovaginal infection
• Assessment
- Instructed not to touch (rinse vaginal canal)
- Observed for erythema, edema, excoriation and discharge
- Asked to describe any discharge, odor, itching, burning, dysuria
- Obtain urine specimen for culture and sensitivity testing (r/o UTI)
- Asked about occurrent of factors (physical & chemical factors, psychogenic factors, medical conditions, use of med abx, new sex
partner, multiple sex partners, previous vaginal infection)
• Diagnosis
- Impaired comfort R/T burning, odor, itching from infectious prices
- Anxiety R/T stressful sx
- Risk for infection or spread of infection
- Deficient knowledge about proper hygiene and preventive measures
• Planning and goal
- Major goals: increased comfort, reduction of anxiety R/T sx, prevention of reinfection or infection of sexual partner, &
acquisition of knowledge about methods for prevent vulvovaginal infection & manage self- care
• Nursing intervention
- Relieve impaired comfort: tx with appropriate med, sitz bath
- Reducing anxiety: explain cause of sx, discuss ways to help prevent vulvovaginal infection
- Prevention reinfection or spread of infection:
➡ pt education (avoid unnecessary abx agents, wear cotton underwear, and not douching
➡ adequate rest, reduction of life stress, healthy diet low in refined sugars
➡ abstain from sexual intercourse when infected, tx for sexual partners, and minimize irritation of affected area
➡ reduce tissue irrigation caused by scratching or wearing tight clothing
➡ Area need to kept clean by daily bathing and adequate hygiene after voiding and defecation
➡ educate the pt about med and demonstrate the procedure if pt don’t know how to use it
- Promoting home, community-based, and transitional care
• Evaluation
- Experiences increased comfort
- Experiences relief of anxiety
- Remains free from infection
- Participates in self care
 Human Papilloma Virus
• Most Common STD In U.S.
• Found in lesion in of skin, cervix, vagina, anus, penis & oral cavity
• Can Lead To Cervical Cancer
• The most common strains of HPV (6 & 11): condylomata (warty growths) that can appear on vulva, vagina,
cervix, and anus. Often visible or may be palpable by pt
• Risk factors: being young, being sexually active, have multiple sex partners.
• May Be No Symptoms
• Causes Genital Warts or Condyloma
• Treatment:
- topical cream apply to external lesions include podfilox (Condylox) and imiquimod (Aldara)
- topical application of trichloroacetic acid, podophyliin (Podofin), cryotherapy, surgical removal
- genital warts are more resistant to tx in pt w/DM, pregnant, smokes, immunocompromised
- should have annual PAP smears b/c of potential of HPV to cause dysplasia
- Use of condoms reduce the transmission, but transmission can occur during skin-t0-skin contact in areas
not covered by condoms
• Prevention is best:
- routine vaccination of boys & girls 11-12 yrs, before they become sexually active
- Recommend for females (13-26 yrs old) and males (13-21 years old)
- 3 different IM doses, with initial dose followed by 2nd dose in 2 mth and third dose 6 mth after the first
dose. Completion of all 3 doses is important for immunity to develop. Contraindicated of pregnant
women
- Women still need cervical cancer screening
 Herpes
• STI, recurrent, lifelong viral infection that causes herpetic lesions (blisters) on external genitalia, vagina,
and cervix
• Painful and blisters that can come and go. No Cure
- recurrences associated w/stress, sunburn, dental work, inadequate rest or poor nutrition, or any
situations that tax immune system
• Genital Herpes: Develop External Blisters
• Transmitted Easily through sex (direct contact), transmitted asexually from wet surfaces or self-
transmission, transmission occurs from asymptomatic viral shedding
• No Vaccine Available
• Three Groups of Herpes Exist: 9 Types (HSV-1: cold sores of lips, HSV-2: associated with genital herpes,
varicella zoster or shingles, Epstein-Barr virus, cytomegalovirus, human B-lymphotropic virus)
• Can pass to infant during delivery
• Signs and Symptoms:
- itching first and pain occur as infected area becomes red and edematous
- begin with macule & papule, and progress to vesicles & ulcers
- in women, labia is usual primary site for lesion
- in men, glans penis, foreskin, or penile shaft is typically affected
- influenza like sx occur 3 or 4 days after lesion appear
- inguinal lymphadenopathy (enlarged lymph nodes in groin), minor temp elevation, malaise, headache,
myalgia (aching muscles), dysuria (pain on urination)
- pain is evident during 1st wk & then decreases. Lesions last 2-12 days before crusting over
- pt should advised to wash their hand after contact with lesions
- Other potential problems: aseptic meningitis, neonatal transmission, severe emotional stress R/T dx
 Herpes Treatment
• No cure for genital herpes infection, but tx is relieve sx (pain)
• management goal:
- prevent spread of infection
- making pt comfortable
- decrease potential health risk
- initiate counseling and education program
• Antiviral Drugs Given: acyclovir (Zovirax), valacyclovir (Valtrex),
famciclovir (Famvir) — suppress sx & shorten the course of infection
• Recurrent episodes often milder than initial episode
• Nursing Interventions:
- relieve pain
- prevent infection and its spread
- relieve anxiety
- increase knowledge about disease and its tx
- promote home, community-based and transitional care
 Nursing process: The patient with a genital herpes infection
• Assessment
- health hx & physical & pelvic exam
- assessed for risk of STIs
- inspected for painful lesions, inguinal nodes (enlarged & tender during occurrence of genital herpes)
• Diagnosis
- Acute pain R/T genital lesions
- Risk for infection or spread of infection
- Anxiety R/T dx
- Deficient knowledge about disease and its management
• Planning and goals
- Major goals: relief of pain & discomfort, control of infection & its spread, relief of anxiety, knowledge of &
adherence to tx regimen & self-care, & knowledge about implication for the future
• Nursing interventions
- Relieve pain: keep lesions clean and proper hygiene practices & sitz bath, increased fluid intake, alert for possible
bladder distention, contact PCP asap if cannot void b/c of discomfort, oral antiviral agents
- Preventing infection and its spread: proper hand hygiene, use barrier methods of sexual contact, adherence to
prescribed med regimens, avoidance of contact when obvious lesions are present
- Relieve anxiety: listen to pt’s concerns and provide info & instructions, refer pt to support group to assist in
coping with dx
- Increase knowledge about disease and its tx: pt education
- promoting home, community-based, and transitional care
• Evaluation
- experiences a reduction in pain & discomfort
- keeps infection under control
- use strategies to reduce anxiety
- demonstrates knowledge about genital herpes and strategies to control & minimize recurrences
 Chlamydia
• Very Common STD, most common causes of endocervicitis
• Most commonly found in young ppl who are sexually active with more than 1 partner
and transmitted through sexual contact
• Bacterial : Must Report Cases To CDC
• Usually No Symptoms but cervical discharge , dyspareunia, dysuria, and bleeding
• Take about 1-3 wk to see the sx
• Complications: conjunctivitis and perihepatitis , PID, increase the risk for ectopic
pregnancy & infertility, risk for HIV
• Diagnosis: urine culture, swab to obtain a sample of cervical or penile discharge from
pt’s partner
• Treatment:
- Obtain Sexual History
- Medications: doxycycline (Vibramycin) for 1 wk or with a single does of
azithromycin (Zithromax)
- pregnant women are cautioned not to take tetracycline b/c potential adverse effect
on fetus, erythromycin may be prescribed
- annual screening for chlamydia recommended for all young women who are
sexually active & older women with new sex partners or multiple partners
 Gonorrhea
• Another Common STD In U.S.
• 25 years and above, need to be screen for chlamydia and
gonorrhea
• Can Transmit To Newborn During Delivery
• Signs and Symptoms: Usually None (often asymptomatic). Men
(burning with urination, swelling in penis). Women (bleeding
during intercourse)
• Complications: PID, tubal infertility, ectopic pregnancy chronic
pelvic pain
• Diagnosis: urine culture, swab to obtain a sample of cervical or
penile discharge from pt’s partner
• Treatment & Nursing Interventions: tx as chlamydia
- all women aged 25 & younger who are sexually active should
be screened annually
 Pelvic Inflammatory Disease (PID)
• Inflammation of Pelvic Cavity begin with cervicitis and involve the uterus (endometritis), fallopian tubes
(salpingitis), ovaries (oophoritis), pelvic peritoneum, pelvic vascular system
• Common cause: gonorrheal and chlamydial organisms, but most cases of PID are polymicrobial
• Fallopian tubes become narrow & results in scarring
• Symptoms:
- Starts With Vaginal Discharge, dyspareunia dysuria, pelvic or lower abd pain, tenderness that occurs after
menses & postcoital bleeding
- Other sx: fever, malaise, anorexia, N/V, headache
- intense tenderness on palpation of uterus or movement of cervix (cervical motion tenderness)
- Sx is acute and severe or low grade and subtle
• Complications:
- pelvic or generalized peritonitis, abscesses, strictures, fallopian tube obstruction may develop
- adhesion, often result in chronic pelvic pain. Require removal of uterus, fallopian tubes & ovaries
• Treatment:
- Broad Spectrum Antibiotics (combination of ceftriaxone (Rocephin), doxycylxine, and metronidazole (Flagyl)
- Tx of sexual partners is necessary to prevent reinfection
• Nursing management:
- Assess physical & emotional effects of PID
- Prepares pt for further diagnostic evaluation & surgical intervention as prescribed if pt is hospitalized
- Recording of V/S, I&O, characteristics & amt of vaginal discharge is necessary as a guide to therapy
- Administers analgesic agent for pain relief
- Adequate rest, healthy diet
- Documentation regarding the sx (vaginal discharge, pain)
- Appropriate infection control practices and perform hand hygiene to prevent spread of infection
 PID: Nursing Interventions
• Educate Regarding Treatment
• Pre and Post-Operative Teaching
• Administer Medications
• Documentation Related To Symptoms
• Good Handwashing Instructions
 Cystocele, Rectocele, Enterocele
• Cause: Stretching Structures
• Some degree of prolapse (weakening go Vaginal Wall allow the pelvic
organs to descend from the location and protrude into vaginal canal
• risk factors: age, parity (particularly vaginal delivery), menopause,
previous pelvic surgery, genetic predisposition
• Cystocele: downward displacement of bladder toward vaginal orifice
from damage to anterior vaginal support structures
- result from injury and strain during childbirth
- appear years later when genital atrophy associated with aging occurs
• Rectocele: Upward Pouching of Rectum that pushes posterior wall of
vaginal forward
- rectoceles & perineal lacerations occur b/c of muscle tears below
vagina
• Enterocele: Prolapse/protrusion of Intestinal Wall Through Vagina
- prolapse results from weakening of support structures of uterus; the
cervix drops and may protrude from vagina
 Cystocele, Rectocele, Enterocele (cont)
• Signs and symptoms:
• Cystocele: C/O Pelvic Pressure, urinary probs (i.e. incontinence, frequency,
urgency). Back & Pelvic Pain
• Rectocele: C/O pelvic pressure, rectal pressure, constipation, uncontrollable
gas, fecal incontinence, Ulcerations & Bleeding
• Treatment:
- Early Treatment - Pessary Inserted (insert w/o surgery) ring-or
doughnut shaped that hold in place. Rubber pessaries must be
avoided in women with latex allergy
- Kegel exercise :
➡ (contracting or tightening vaginal muscles to strengthen
weakened muscles) work really good in early stage of cystocele
- Colpexin sphere: treat pelvic organ prolapse, support floor muscles
and facilitates exercise of these muscles. It’s removed daily for
cleaning
 Cystocele, Rectocele, Enterocele (cont)
Surgical Treatment:
• Anterior Colporrhaphy (repair anterior vaginal wall)
• Posterior Colporrhaphy (repair of a rectocele)
• Perineorrhaphy (repair of perineal lacerations)
• frequently performed laparoscopically, resulting in short hospital
lengths of stay and good outcomes
• pre and post care when dealing with surgery (nursing
intervention)
• cystocele: pt needs to void. If pt cannot void in the past 6 hrs after
surgery then need to put in foley catheter. If not, complications
can occur
 Uterine Prolapse
• Uterine Prolapse: Stretched Ligaments. As uterus descends, it pull
vaginal wall & bladder & rectum with it
• Sx: pressure & urinary probs (incontinence or retention) from
displacement of bladder
- sx are aggravated when woman cough, lift a heavy objects, or
stands for a long time
• Surgery
- Uterus is sutured back into place and repaired to strengthen &
tighten the muscle bands
- Shorten Ligaments
- In postmenopausal women, uterus may be removed
(hysterectomy ) or repaired by colpopexy
- Removal or Repair: manage uterine prolapse, hysterectomy
- Lifestyle changes, Pessaries, pelvic floor muscle training
 Nursing Interventions
• Pre & Post-Operative Care / Teaching
• Self-Care Education: Kegel Exercise
• Home Care: Kegel exercise
• Teach the pt to do perineal care after each void and bowel
movement b/c if not clean it, can lead to infection
• Light wt ice pack (not place the directly on the pt), put it on the
bed and not on the pt
• Pericare
• pain management: routine pain pca
•
 Nursing management:
• Implementing preventive measures
- Early visit to PCP permit early detection of probs
- Educated to perform pelvic muscle exercises “Kegel exercise” (increase muscle mass + strengthen muscles
that support uterus)
• Implementing preoperaitve nursing care
- before surgery, pt need to know extent of proposed surgery, expectations of post-op period, & effect of
surgery on future sexual fxn
- laxative and cleansing enema prescribed before surgery for rectocele repair
- placed in lithotomy position for surgery
• Initiating postoperative nursing care
- prevent infection and pressure on existing suture line
- require perineal care and preclude using dressings
- encouraged to void within a few hrs after surgery for cystocele and complete tear
- after 6 hrs, pt haven’t void or report discomfort/pain in bladder region, need to be catheterized
- an indwelling catheter may be indicated for 2-4 days
- perineum cleaned with warm, sterile saline solution and dried with sterile absorbent material after each
voiding/BM
• promoting home, community-based, and transitional care
- prevention of constipation, recommended exercise, avoid lifting heavy objects or standing for prolonged
period
- report an pelvic pain, unusual discharge, inability to carry out personal hygiene, vaginal bleeding
- perineal exercise, fuv with gynecologist
 Endometriosis
• Chronic disease affecting btwn 7%-10% of women of reproductive age
• Overgrowth of Endometrium.Benign lesion or lesions that contain endometrial tissue found in pelvic cavity
outside uterus
• High incidence among pt who bear children late and those with fewer children
• Can Be Familial predisposition to endometriosis
• other factors: shorter menstrual cycle (less than every 27 days), flow longer than 7 days, outflow
obstruction, younger age at menarche
• Signs and Symptoms:
- short cycle (below 27 days)
- dysmenorrhea, dyspareunia, pelvic discomfort/pain
- painful intercourse
- depression, loss of work d/t pain, relationship difficulties
- infertility
• Assessment and Diagnosis:
- Health hx (menstrual pattern)
- Bimanual pelvic exam, fixed tender nodules are palpated, uterine mobility may be limited
- Laparoscope Confirms Diagnosis and help stage disease
- Ultrasonography, MRI, CT scans: visualize endometriosis
• Stage 1: pt has superficial or minimal lesions
• Stage 2: mild involvement
• Stage 3: moderate involvement
• Stage 4: extensive involvement and dense adhesions, with obliteration of the cul-de-sac
 Endometriosis (Cont)
• Usually No Symptoms
• Routine exam is required (health hx and bimanual pelvic exam)
• Pregnancy often alleviates sx, b/c neither ovulation nor menstruation occurs
• Treatments:
- If pt does not have sx, routine exam is required
- NSAIDS, Birth Control Pills (oral contraceptive agents), hormone therapy (androgen), GnRH agonists, or
Surgery
- Palliative Treatment:
➡ Medications: analgesic agents & prostaglandin inhibitors
➡ Hormones therapy: effective in suppressing endometriosis & relieve dysmenorrhea (menstrual pain)
➡ Oral contraceptive agents: provide effective pain relief & prevent disease progression (side effect: fluid
retention, wt gain, nausea)
- Surgery:
➡ Laparoscopic may be used to fulgurate (cut with high frequency current) endometrial implants & release
adhesions
➡ Laser; surgery
➡ Endocoagulation and electrocoagulation
➡ Laparotomy
➡ Abdominal hysterectomy
➡ oophorectomy (removal of ovary)
➡ bilateral salpingo—oophorectomy (removal of ovary and its fallopian tube)
➡ appendectomy
• Nursing Interventions:
- Pt teaching regarding aspect of d/o, tx, provide outside resource if surgery need to take place
- assess the pt
 Cancer of the cervix
• Prevention & Early Detection Important: regular pelvic exam,
regular pap smear
- Encourage delay first intercourse, avoid HPV infection, engage only
in safe sex, smoking cessation, and receive HPV immunization
• Signs and Symptoms: No Early Symptoms but they may have thin
vaginal discharge after intercourse, regular bleeding and pain after
intercourse
• May Have Thin Watery Discharge
• Symptoms Seen With Advanced Cancer: rectal bleeding, edema in
extremities, pain when urination, sx can spread to other area (metastasis)
• If found early, there is 100% of survival
• Diagnosis:
• Pap Smear: abnormal. Bx will be done and be positive for CIN III
• Staging Use TNM System:
• Screening when they are sexual active, around 21 years old
 Treatment for cervical cancer
• Depends On Stage
• Mild Dysplasia: Loop Electrosurgical Incision
• In Situ: Laser, Cryosurgery, or Conization
• Invasive Cancer: Radiation, Surgery or Both
• Chemotherapy For Advanced Cancer
• Follow up is necessary b/c it can reoccur
• complication after surgery: infection, hemorrhage
• leg edema (bilateral) if cancer return
 Cancer of the uterus: Endometrium

• Starts In Endometrium: originating in the lining of

uterus. Endometrial Carcinomas

• Develops Slowly: Common in Postmenopausal Women

• Diagnosis and Assessment

• If Irregular Vaginal Bleeding, Should Evaluate
• Biopsy Endometrium to confirm dx
• Transvaginal Ultrasound: look for thickening of endometrium.
Low estrogen will cause the thickness
 endometrial cancer treatment

• Surgical Staging
• Total or Radical Hysterectomy; Other Surgery (total or
radical hysterectomy and bilateral salpingo-oophorectomy,
lymph nose sampling)
• Lab: CA-125 Is Elevated
• External or Internal Radiation
• With Reoccurrence: Surgery & Radiation. Usually
reoccurrence will be seen in the ovary
• progestin therapy and chemotherapy?? Pt should prepared for
side effect of nausea, depression, rash, mild fluid retention
• SIT???
 Cancer of the vulva

• Rare, High Incidence During Menopause

• Possible risk factors: smoking, HPV infection, HIV infection, and immunosuppression

• Most Common Site Affected: Labia Majora

• Cause: Unknown, can be cause from HIV or HPV

• Complications: Can Spread to lymph node if Untreated

• Diagnosis & Treatment: Bx perform on vulvar lesion that permits, ulcerates, or fails to heal quickly
with proper therapy

• vulvar malignancies may appear as a lump or mass, redness, or lesion that fails to heal

• nursing assessment: assess for complication, pre and post opt care, assess for infection/bleeding/
possible shock?? , monitor pt’s bloodwork, monitor side effect of chemo and radiation, assess for
pain and management
 Cancer of the vagina

• Rare: Is Not Usually The Primary Site

• Mostly Seen In Post-Menopausal Women (older than 70).
Has been link to HPV and smoking
• Cause: No Definite Cause
• Signs & Symptoms: vaginal discharge, burning sensation,
spotting after intercourse, vaginal bleeding, pelvic pain
• Diagnosis: Pap Smear; Colposcopy Confirms Diagnosis
• Treatment & Complications: need to be early (local excision,
topical chemotherapy, or laser). Radical vaginectomy
 Cancer of the ovaries

• Tumors Are Hard To Detect, leading cause of gynecologic

cancer death in U.S. (deep in the pelvic)
• No Adequate Screening Available
• 1 in 70 Will Develop Disease/ovarian cancer
• No early screening for ovaries cancer
• Family History Most Significant for risk factor
• Gene Mutation: BRCA1 & BRCA 2
• diagnose by age 60 or age 40
• Being older, early menarche, late menopause, obesity, and
family hx of in first degree relative increase the risk of
ovarian cancer
 Ovarian cancer
• Risk factor: family hx, mutation in BRCA1/BRCA2, older age,
early menarche, late menopause, obesity
• Nonspecific Symptoms: increase abd girth late sign, pelvic
pressure, bloating, back pain, constipation, abd pain, urinary
urgency, indigestion, flatulence, increased waist size, leg pain,
and pelvic pain. Sx are often vague, many women tend to ignore
them
• “silent killer”, enlargement of abdomen from an accumulation of
fluid is common sign. A palpable ovary who has gone through
menopause is investigated immediately b/c ovaries normally
become smaller and less palpable after menopause
• Assessment: Enlarged Ovary On Exam
• Diagnosis: MRI, transvaginal and pelvic Ultrasound
• Chest X-ray; Abdominal CT to R/O Spread
• Lab: CA-125 (Cancer Antigen)
• Abd CT scan w/ and w/o contrast used to r/o metastasis
 Ovarian cancer treatment
• Surgery With Staging: or bx with the staging is basic of tx
• Surgical removal is tx of choice
• Omentum, tumor debulking, para-aortic and pelvic lymph nose
sampling, diaphragmatic bx, randome peritoneal bx, cytologic
washing
• Postoperative management: taxanes or platinum-based
chemotherapy
• Borderline tumors resemble ovarian cancer but have much more
favorable outcomes
• Exploratory Surgery
• Use TNM Staging: Guides Treatment
• Other Surgery: Total Hysterectomy & Debulking
 Medications used to treat ovarian cancer
• IV Chemotherapy: Usually 6 Cycles of Treatment
• Monitor CA-125 & Pelvic Exam
• Leukopenia, neurotoxicity and fever may occur
• Paclitaxel (Taxol) plus carboplatin (Paraplatin)
• Liposomal Treatment: delivery of chemotherapy in a liposome, allow
highest possible dose of chemotherapy to tumor target with reduction
in adverse effects. Pt must be monitored for bone marrow suppression
and GI and cardiac effect
• Future Treatments: gene therapy. Ovarian cancer can come back
• Nursing Interventions: based on tx plan
• Provide emotional support, administer for any meds, comfort measures
for women with ascite, pt with pleural effusion may experience SOB,
hypoxia, pleuritic chest pain, and cough. Thoracentesis is performed to
relieve these sx. Protect isolation b/c their immune system is
suppressed.
 Hysterectomy
• Surgical removal of uterus to treat cancer, dysfunctional uterine bleeding,
endometriosis, nonmalignant growths, persistent pain, pelvic relaxation
and prolapse, and previous injury to uterus
• Total Hysterectomy: Remove Cervix and Uterus
• Supra-Cervical: Leave Cervix In
• Radical Hysterectomy: removal of uterus and surrounding tissue (upper
third of vagina and pelvic lymph node)
• Preoperative Care/Preparation: pt teaching (stop taking anticoagulant med,
NSAIDs, and vitamin E prior to surgery to reduce the risk of bleeding).
Prophylactic abs agents may be given prior to surgery and d/c next day
• Postoperative Nursing Care:The principles of general postoperative care
for abdominal surgery apply. Major risks are infection and hemorrhage. In
addition, because the surgical site is close to the bladder, voiding problems
may occur, particularly after a vaginal hysterectomy. Edema or nerve
trauma may cause temporary loss of bladder tone (bladder atony), and an
indwelling catheter may be inserted. Monitor for sx
•